Hong Kong College of Family Physicians

To assess applied knowledge, clinical reasoning, clinical skills, communication skills and professional attitudes in the context of consultations and patient examinations.

Examination format

This will comprise 14 or more stations of either 8 minutes or 19 minutes each. There will be a combination of clinical cases and rest periods. It will take approximately 4 hours to complete all the stations.

For both the 8 minutes and 19 minutes stations, clear instructions will be provided. It is critical that you read each question carefully, and understand the task(s) required.

8 Minutes stations

The 8 minutes consultation stations will require you to focus on one or two aspects of a consultation. These are not designed to represent whole consultations compressed into 8 minutes. Therefore there is no intention to promote 'eight minute medicine'. The emphasis may be on history taking, physical examination, investigations (selection or interpretation), performance of procedures, making a diagnosis or a clinical decision, management aspects, counselling, critical appraisal or any other aspect of general practice/family medicine.

Although your task will be a focused one, you will be expected to exhibit a 'whole patient' approach by demonstrating the general practice skills of communication, empathy, history taking (relevant and systematic), appropriate examination (relevant and systematic), patient education, preventive care, opportunistic medicine and involvement of carers, as they are appropriate to the case.

Stations may also involve the candidate in a discussion with an examiner to explore more complex issues, e.g. medico-legal dimensions, ethical dilemmas, population health, hot current issues, practice management etc.

19 Minutes stations

Candidate procedure

		Candidates must hand in their bags (other than medical bags) and any electronic devices at the administration desk.
		Candidates will be given name tags, time slot slips, rotation schedule and examination hall floor plan upon registration.
		A folder with candidate's instruction sheet and blank paper is placed on the sitting chair besides each examination room. Candidate must leave the folder on the chair before entering examination room. A same set of instruction is available inside examination room.
		Candidates have a maximum of 3 minutes to read the instructions before each station. Read the instructions carefully and identify what is/are the expected requirement/s in that particular station.
		Candidates may make notes on assigned blank paper during their reading time, which they can use and take into the examination room with them. Candidates are not allowed to take these note papers with them out of the examination room at the conclusion of each case.
		Candidate should enter the consultation room when notified by the alarm according to centralized timing.
		Candidate must give the right time slot slip to examiners upon entering the consultation room. And a short briefing will then be delivered by the examiner.
		Timers with audible alarm are not allowed during examination. Timers will not be provided during the examination. Timers in examination room are for examiner's reference only and may not be synchronized with centralised timing.
		Examiners may inspect anything that a candidate brings into the examination room, and may at their sole discretion forbid the admission to the room of any materials that they deem unsuitable.
		There will be no warning signals within the stations.
		Candidate may interact with role playing examiners, actor patients, real patients, equipment/ mannequins in the examination room.
		Examination findings, surgery tests and investigation results may be
	-	given verbally by the observing examiner in response to candidate's questions
	-	on a printed sheet to be handed to candidate
	-	performed by the candidate on real or role playing patients/examiners
	-	given as printed or photographic material (e.g. photos, ECGs, pathology, imaging)
		Candidate must leave the examination room immediately when signaled by centralized timing.

Marking on descriptors

Each station will have different marking schedules: a station which calls for a focus on history taking will have a marking schedule which is weighted towards this aspect; whereas a station where developing a management plan is being examined will have a marking schedule which reflects its importance.

Furthermore, if a station presents a diagnostic problem where you need to take a history to elicit your problem solving skills and discuss your differential diagnoses with the patient, simply arriving at the 'right' diagnosis may not be enough to pass the station. Other important elements such as taking the history in a relevant way, a systematic approach and demonstrating good communication skills may also contribute to your score in this station.

There are usually 3-5 descriptors used in the marking schedule of each station.

Examples of the descriptors are outlined below. (Note that these examples are not exclusive and there may be more in the actual list)

	1.	Communication and rapport
		Competence in this area demonstrates genuine respect, rapport and empathy. It allows the patient to talk freely and to feel at ease in a non-judgmental atmosphere. It includes active listening, appropriate maintenance of eye contact, recognition of verbal and non-verbal cues and body language. It demonstrates the effective use of silence and suitable language with appropriate mix of open and closed questions. It enables the exploration of concerns and expectations and allows recognition of the significance of the patient's words.
	2.	Inter-professional communication skills
		Candidates are rated on their communication skills at an inter-professional level.
	3.	History taking
		Candidates are rated on their ability to take a relevant and organized history; following appropriate cues and eliciting both positive and negative details important to the assessment and management of the patient.
	4.	Physical examination
		Candidates are rated in their ability to perform an appropriate and systematic examination which is focused and not overly inclusive. Relevant and specific findings should be elicited.
	5.	Physical examination technique
		Candidates are rated on their physical examination technique. Systematic and appropriate examination techniques should be employed and explained to the patient. Candidates should demonstrate respect of the patient and concern for the patient's safety, comfort and modesty. Candidates should wash their hands (or use alcohol hands-rub) at the end of the examination.
	6.	Physical examination findings
		Candidates are rated on their ability to detect physical examination findings accurately and to interpret them correctly.
	7.	Investigations
		Candidates are rated on their ability to select relevant, cost effective investigations in an appropriate sequence, displaying consideration for the safety and comfort of the patient.
	8.	Diagnosis
		Candidates are rated on their ability to make an accurate diagnosis based on interpretation of the history, physical examination and investigations.
	9.	Problem definition
		Candidates are rated on their ability to identify, define and prioritise the physical, psychological and social issues involved for the patient, the family and the community.
	10.	Medical knowledge
		Candidates are rated on their medical knowledge of the physical, psychological and social issues involved in the questions.
	11.	Public health issues
		Candidates are rated on their awareness of, and ability to deal with the public health and social issues raised by this case.
	12.	Management
		Candidates are rated on their ability to manage the issues raised in this case, both now and in the future. Candidates should offer effective explanations, education and choice to patients, and involve the patient, family and relevant community resources in the immediate and ongoing management plans. Candidates should demonstrate responsibility for the immediate and ongoing management of the patient.
	13.	Procedural skills
		Candidates are rated on their ability to perform the procedure appropriately and competently with regard for the patient safety and comfort.
	14.	Ethical and medico-legal issues
		Candidates are rated on their ability to deal with the ethical, medico-legal and professional issues raised by the case.
	15.	Critical appraisal skills
		Candidates are rated on their ability to critically appraise an article and to identify its strength and weakness. This may include analysis of statistical data.

For each descriptor of the clinical case, candidate will be marked on a rating scale i.e. serious deficiencies, fail, borderline fail, borderline pass, pass, outstanding.

The pass mark varies slightly from examination to examination, as determined by standard setting techniques. There is no intention to pass or fail a fixed percentage of candidates. Instead, the intent is to make fair and appropriate pass-fail decisions. Those who meet reasonable criteria of knowledge, skills and attitude pass; those who do not meet competency criteria, regardless of their relative standing, fail.

The Examination Matrix overleaf provides a valid base from which to "sample" for an assessment of family medicine knowledge, skills and attitudes

Download Exam Matrix